DiaGame: Gamification for the Education of Patients with Diabetes

Diabetes is a disease with potentially serious consequences, but fortunately, we can live well with diabetes by adapting our lifestyle. However, this is easier said than done. In the DiaGame project, the game SugarVita is being further developed. The game SugarVita visualizes the impact of food, exercise, and medication on personal glucose levels, helping to make better choices in nutrition, exercise, and medication. Together with healthcare providers, DiaGame can change the approach to diabetes care by utilizing data science, artificial intelligence, and simulation models to support a personalized diabetes game. Ultimately, this will improve the quality of life for patients and alleviate the socio-economic and medical burdens associated with diabetes.

In spring 2024, we spoke with project leaders Natal van Riel and Annelies Bobelyn from TU/e. Natal is a professor of Biomedical Systems Biology in the Department of Biomedical Engineering at Eindhoven University of Technology, where he leads the Computational Biology group and the research program Systems Biology and Metabolic Diseases. Annelies is an assistant professor in the Department of Industrial Engineering & Innovation Sciences at Eindhoven University of Technology (TU/e). Her expertise includes strategy, technology entrepreneurship, learning methods, and technology and knowledge transfer.

SugarVita and DiaGame

Internist Prof. Dr. Harm Haak of Máxima MC, in collaboration with TU/e, developed the digital board game SugarVita. With this digital board game, people with type 2 diabetes can change their lifestyle, and the effect of food, exercise, stress, and medication on blood sugar can be predicted. SugarVita players experience a day as someone with diabetes would in real life. By digitally living with diabetes in the game, they learn to manage their condition effectively.

Natal explains: "Gamification has the great advantage of changing habits in a fun and appealing way. Through wearables and smart devices, we aim to integrate with someone's daily life, so we can personalize the algorithm underlying the game and ensure that the gaming experience aligns with the patient's real-life situation."

DiaGame: Improvement of SugarVita

By applying data science methods, the simulator is further developed into a fully personalized version in the DiaGame project. SugarVita is further elaborated/improved in various aspects to better represent reality, with a wide range of available foods and the addition of various types of physical activity. Emotional stress is also a significant factor in diabetes and will be incorporated into the new game. Additionally, the attractiveness of the game is enhanced. Natal adds: "There is also a need to involve the family in the game so that they better understand the complexities of life for a patient with diabetes and how various daily factors (such as food, exercise, sleep) can affect it."

The goal of DiaGame is to create a data-driven, personalized serious game that enables people with diabetes to manage the disease they are facing.

Partners

The DiaGame project is funded by the NWO research program Data2Person. Maxima Medical Center provides access to patients and ensures approval for the patient study by the medical ethics committee. Additionally, spin-off company HRH Diabetes Games, founded by Harm Haak, is involved (with DiaGame emerging as a follow-up to SugarVita).

Three Work Packages

DiaGame consists of five work packages, namely;

1. The clinical study; collecting data through observation of 60 patients with diabetes (50 type 2 diabetes and 10 type 1 diabetes patients)
2. Data processing using machine learning algorithms and methods
3. Improvement of the computer simulation model with insights into changes in glucose levels (= the engine of the SugarVita game)
4. Enhancement of the game
5. Testing the improved game with patients with diabetes

Work package 1 has been completed. Natal proudly describes how experimental use of nudging was employed with participants in the study. "An app was built on the watch that asked about the patient's mental vitality by triggering a vibration signal at a certain moment. The patient could then indicate how they felt using emoticons. This allowed us to collect a lot of data, providing valuable insights," he says.

Take-off and Top-up

The DiaGame project is supplemented by two smaller projects to strengthen the potential for societal impact and knowledge utilization of the DiaGame project. This includes the Take-off for research into a business model to commercialize the game. The Top-up subsidy - focused on valorization - is used to better understand the process of obtaining certification for the game.

Challenging Practice

Annelies is involved in the Take-off research and elaborates on it. "The idea was to get the game to patients together with practice nurses. After several discussions, we realized that adopting a new way of working was quite challenging. We also found that not everyone could easily use the game; an important target group lacks sufficient digital skills. A more direct route might help us bring our product to market," she explains.

Another challenge is getting the game reimbursed by health insurers. Annelies mentions that they are still exploring this because it's difficult to provide real evidence of actual lifestyle improvement. The certification process is also an open question in order to actually bring the game to market. "This certification can then also contribute to convincing practice nurses, but it does come with a price tag," says Natal.

Impact & Valorization

DiaGame primarily has a societal goal; a relevant addition to patient education and educating as many people as possible. Within DiaGame, a small quantitative valorization study (WP 5) is being set up to see how the adapted game (still without personalization) resonates with patients. Annelies further explains: "To reach the more challenging target groups, keep the game workable, and get it to market, more resources are needed. DiaGame is now positioned between research funding and start-up funding. Due to the societal goal and the impact we want to make, this is not easy and still a major issue."

For more information, visit https://diagame2.wordpress.com/